Aetna Sr. Provider Data Analyst in Baton Rouge, Louisiana

Req ID: 52113BR

POSITION SUMMARY

Position will be responsible for maintaining Provider Data integrity within Claims adjudication system. Coordination with Configuration team to ensure proper Provider setup. proactively running data queries, analyzing and correcting results.

Fundamental Components:

  1. Position responsible for maintaining provider data integrity for reporting, directory and claims adjudication purposes.

  2. Position responsible for creating and running inquiries to identify provider data inconsistency patterns and potential issues.

  3. Position responsible for creating automated data uploading resolutions to support operational efficiencies and data integrity.

  4. Position will coordinate with system configuration team to ensure data is captured and maintained to maintain regulatory compliance.

  5. Position will be responsible for analyzing queries in an effort to improved data quality and support network adequacy.

    BACKGROUND/EXPERIENCE desired:

    5+ Years of experience and knowledge of Provider Data Services systems and other end user applications.

    3+ Years of healthcare insurance knowledge, including provider data, network reimbursement methodologies, directory and credentialing

    3+ years of collaboration with systems configuration/IT teams

    Experience with network adequacy reporting and data clean-up initiatives

    Experience with creating and managing automated resolutions that support operational efficiencies and data integrity

    EDUCATION

    The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

    LICENSES AND CERTIFICATIONS

    Managed Care/Managed Healthcare Professional is desired

    Information Technology/Microsoft Access is desired

    Operations Support/ is desired

    FUNCTIONAL EXPERIENCES

    Experience/Functional_Focus/1-3 Years

    Information Technology/Application development/4-6 Years

    Information Technology/Application maintenance & support/1-3 Years

    Network Management/Provider data services/4-6 Years

    TECHNOLOGY EXPERIENCES

    Network/Provider data management/4-6 Years/Power User

    Network/Provider compliance/1-3 Years/Power User

    Development Experience/Client/Server/4-6 Years/Power User

    REQUIRED SKILLS

    General Business/Ensuring Project Discipline/FOUNDATION

    Technology/Developing Software Solutions/FOUNDATION

    Technology/Selecting and Applying Technology Solutions/ADVANCED

    DESIRED SKILLS

    General Business/Applying Reasoned Judgment/MASTERY

    General Business/Maximizing Work Practices/ADVANCED

    General Business/Turning Data into Information/MASTERY

    Telework Specifications:

    Must live in the Baton Rouge, LA area. Office based position to begin, and Work from Home / flexible work schedule may be considered after successful 6 month training period.

    ADDITIONAL JOB INFORMATION

    Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

    We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

    Together we will empower people to live healthier lives.

    Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

    We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

    Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

    Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Health Care